Chemo for Choriocarcinoma – pro

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta and includes the most agressive type, choriocarcinoma.  Histologically distinct disease entities encompassed by this general terminology include complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. In agressive high-risk cases,  aggressive multiagent chemotherapy and individualized multimodality therapy is warranted . At present, treatment with single-agent methotrexate or actinomycin D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and oncovin) are recommended for intermediate or high-risk disease. A recent guideline says this about the choice of chemotherapy: “•Women with high-risk metastatic disease should be treated with multiagent chemotherapy. This includes triple therapy with methotrexate, dactinomycin, and either chlorambucil or cyclophosphamide. More recent regimens further incorporate etoposide with or without cisplatin into combination chemotherapy.”.

Royal College of Obstetricians and Gynaecologists (RCOG). The management of gestational trophoblastic neoplasia. London (UK): Royal College of Obstetricians and Gyneacologists (RCOG); 2004 Feb. 7 p. (Guideline; no. 38). [16 references]

American College of Obstetricians and Gynecologists (ACOG). Diagnosis and treatment of gestational trophoblastic disease. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2004 Jun. 13 p. (ACOG practice bulletin; no. 53). [49 references]

Kufe D (2000). Benedict RC, Holland JF. ed. Cancer medicine (5th ed. ed.). Hamilton, Ont: B.C. Decker. ISBN 1-55009-113-1.

^Rustin GJ, Newlands ES, Begent RH, Dent J, Bagshawe KD (1989). “Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma”. J. Clin. Oncol. 7 (7): 900–3.

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